Ocular signs, symptoms and tear function tests of papulopustular rosacea patients receiving azithromycin

Background  Tetracycline derivatives provide moderate benefit in the treatment of ocular rosacea. Recently, azithromycin has been found to be an effective alternative in the treatment of cutaneous papulopustular rosacea.
Objective  We planned a study to evaluate the effects of azithromycin on ocular symptoms, signs and tear function tests of papulopustular rosacea patients.
Methods  An open-labelled study was performed in a population of 20 papulopustular rosacea patients.
Results  Eighteen subjects completed the trial. Significant improvement was seen in ocular symptoms, eyelid findings and conjunctival hyperaemia scores ( P  = 0.002, P <  0.0001, and P  = 0.005, respectively). Therapeutic benefit was not observed in ocular surface staining scores. Baseline values of Schirmer test results were within normal limits. No significant side-effects were observed.
Limitations  The study population is limited to dermatology patients who had been referred to the ophthalmology clinic.
Conclusion  Azithromycin may be a new promising therapeutic alternative in ocular rosacea.

Conflicts of interest

None declared.     

Psychological and sympatho-adrenal status in patients with cystic acne

BACKGROUND: Patients with cystic acne (CA) frequently report feeling self conscious, anxiety and social isolation. METHODS: Mood characteristics as well as self-esteem scores of 38 patients with CA were evaluated before and after 30 days treatment with isotretinoin. A high pressure, liquid chromatography method was used for the evaluation of catecholamines (epinephrine (E) and nor-epinephrine (NE)) in the blood of the patients at the time of the study and in controls (n = 30) after their psychological testing. Moreover, E and NE were measured in the blood of eight healthy volunteers before and after 1 month 'treatment' with the drug. RESULTS: The CA subjects evidenced anxiety and high catecholamine plasma levels (E = 98.0+/-0.8 pg/ml, NE = 250.8+/-56.6 pg/ml) before treatment compared to controls (E = 71.8+/-23.0 pg/ml, NE = 190.0+/-52 pg/ml, P < 0.006), and these levels were lower (E = 75.4+/-21.4 pg/ml, NE = 202.0+/-49.9 pg/ml, P < 0.001) when their psychological status returned to normal after treatment. No differences were observed in E and NE levels in the eight healthy volunteers who received the same dose of the drug at the same time of study. CONCLUSIONS: It is suggested that not only the psychological status is influenced in subjects with CA but also their sympathoadrenal system.     

Temporal changes in sebum excretion and propionibacterial colonization in preadolescent children with and without acne

BACKGROUND: It is generally accepted that the onset of sebum secretion occurs before puberty in boys and girls as a result of increasing androgen output during the adrenarche. Propionibacteria are part of the commensal skin flora and, in adults, are found in highest numbers in sebum-rich areas of skin such as the face and upper trunk. Previous studies investigating the association between sebum output and propionibacterial population densities have been cross-sectional and have been carried out mainly in adults. OBJECTIVES: The purpose of this study was to examine the association between the onset of sebum secretion and expansion of the propionibacterial flora in a population of early adolescent children aged between 5.5 and 12 years, and to evaluate the temporal relation between the two factors longitudinally. In addition, the study aimed to evaluate the change with age in sebaceous gland activity and propionibacterial colonization on the skin and in the nares between children who developed acne and those who did not. METHODS: Biannual examinations of volunteers included age, pubertal (Tanner) stage, weight and height, lesion counting on the face, propionibacterial colonization on the skin surface and in the nares and sebum secretion. A longitudinal analysis based on all observations of each subject throughout the study was applied to examine the change of sebaceous gland activity and propionibacterial colonization with age and pubertal stage. A generalized estimating equation was used with a 0.05 level of significance. RESULTS: The commencement of sebum production was asynchronous, with only a small number of follicles initially starting to secrete sebum onto the skin surface. The number of secreting follicles and the area of sebum increased with age and pubertal stage (P < 0.0001, P < 0.05, respectively). Numbers of propionibacteria on the skin tended to increase after the age of 9 years, but not significantly so. In contrast, numbers of propionibacteria in the nares increased significantly with age (P < 0.0001) but not with pubertal maturation. Children who developed acne had higher sebum output and propionibacterial densities with increasing age than children who did not develop acne. This effect was significant for the increase of total sebum area with age in pubertal children (P = 0.0023), the increase in number of secreting follicles with age (P = 0.020) in prepubertal children, and the increase in propionibacteria densities in the nares with age (P = 0.0005) in pubertal children. Sebaceous gland activity and propionibacterial numbers on the skin surface remained unchanged with increasing age in children who did not develop acne. Propionibacterial population densities in the nares increased with age regardless of the development of acne. CONCLUSIONS: Onset of sebum secretion and consequently expansion of the propionibacterial skin flora occur earlier in children who develop acne than in children of the same age and pubertal status who do not develop acne. These observations suggest that postponing the onset of sebum production or the expansion of the propionibacterial skin flora until after puberty may represent ways of preventing the disease or minimizing its severity. Determinants of propionibacterial colonization on the skin and in the nares may be different.     

Mood changes and clinical decision making in adolescent patients on isotretinoin therapy for acne vulgaris

Although numerous studies have demonstrated no causal relationship between isotretinoin and depression or suicide, subtle mood changes and idiosyncratic mood symptoms have been reported in patients on isotretinoin treatment for acne vulgaris, and few studies have described the full range of mood symptoms and clinical course after a mood change arises. We reviewed 247 patients, ages 10–25 years, with acne vulgaris on isotretinoin and found that 26/247 (10.5%) patients experienced mood changes, the most common being depressive symptoms, anxiety, aggression, and emotional lability. Regardless of treatment management, 22/25 (88%) patients experienced improvement of mood symptoms to baseline, and 22/25 (88%) were able to complete their isotretinoin course without symptom recurrence. Our findings highlight the importance of monitoring for a broad range of mood changes in patients on isotretinoin, especially those related to a pre-existing mood disorder and including those which do not meet formal criteria for a psychiatric disorder.     

New and emerging treatments in dermatology: acne

ABSTRACT:  Topical retinoids, benzoyl peroxide, azelaic acid, and topical and oral antibiotics remain the milestone of treatment for mild to moderate acne vulgaris. Oral isotretinoin is useful for the treatment of severe nodular acne, treatment-resistant acne, and acne with a risk of physical or psychological scarring. Hormonal treatment in female acne is useful in resistant or late-onset acne. With increasing concerns regarding teratogenicity of isotretinoin and increasing antibiotic resistance, there is a clear need for therapeutic alternatives to these long-used treatments. Research in the pathogenesis of acne has allowed for new therapies and future perspectives regarding acne to evolve. They include low-dose long-term isotretinoin regimens, insulin-sensitizing agents, 5α-reductase type 1 inhibitors, topical photodynamic therapy, new combination formulations, dietary interventions, and antiinflammatory agents such as lipoxygenase inhibitors.     

广州市天河区青少年痤疮患病情况及危险因素分析

目的:评估青少年痤疮患病情况及其危险因素。方法:采用横断面问卷调查方法,随机整群抽取2552人12~20岁的青少年,进行问卷调查。结果:总患病率为32.8%,其中男34.2%,女31.6%,两性间患病率差异无统计学意义(P=0.161);11~16岁为青少年痤疮初发高峰期。结论:广州市天河区青少年痤疮初发年龄为11~16岁,危险因素有消化道功能紊乱、生活环境、生活习惯、遗传、内分泌等。     

Congenital adrenal hyperplasia and acne in male patients

Seborrhoea is one pathogenic factor for acne. Androgens induce sebum production, and excess androgen may provoke or aggravate acne. In women an androgen disorder is frequently suspected when acne is accompanied by hirsutism or menstrual irregularities. In men acne may be the only symptom of androgen excess. We report three male acne patients in whom hormonal screening revealed irregularities of androgen metabolism suggestive of late-onset congenital adrenal hyperplasia and who benefitted from low-dose glucocorticoids. Disorders of androgen metabolism may influence acne not only in women, but also in men, and these patients may benefit from low-dose glucocorticoid therapy.     

异维A酸隔日疗法和每日疗法治疗痤疮疗效比较

目的:观察异维A酸(泰尔丝)隔日疗法和每日疗法治疗痤疮的疗效,以及在保证疗效的前提下唾液腺分泌减少的发生率.方法:将受试者分为两组,即异维A酸隔日疗法B组(试验组)和每日疗法组(对照组).试验组中体重≥50kg者,隔日口服异维A酸10 mg,每日3次;体重＜50 kg者,隔日口服异维A酸10 mg,每日2次.对照组中体重≥50 kg者,每日口服异维A酸3次,每次10mg;体重＜50 kg者,每日口服异维A酸2次,每次10mg,两组患者疗程均为6周.结果:经过6周的治疗,试验组患者有效率为77.17%,对照组患者有效率为85.00%.第2、4、6周末时试验组和对照组患者唾液腺分泌减少的发生率分别为26%、31.25%、32.18%和28.87%、34.12%、48.68%.结论:异维A酸隔日疗法治疗痤疮的疗效与每日疗法相当,唾液腺分泌减少的发生率更低.     

Efficacy and tolerability of low-dose spironolactone and topical benzoyl peroxide in adult female acne: A randomized,double-blind,placebo-controlled trial

Effective therapies for adult female acne (AFA) are limited. Oral spironolactone (SPL), 100–200 mg/day, is currently used off-label to treat AFA. However, high-dose SPL results in clinically significant side-effects which prevent widespread use in clinical practice. The efficacy of low-dose spironolactone in AFA is unknown. We examined the efficacy and tolerability of low-dose (25–50 mg/day) oral SPL in Thai women with moderate AFA. A randomized, double-blind, placebo-controlled trial was conducted for 12 weeks. Moderate AFA patients aged between 25 and 45 years received a combination of daily topical benzoyl peroxide (BP) 2.5% plus either SPL 25 mg (SPL25 group), SPL 50 mg (SPL50 group) or placebo. We performed total acne counts and Adult Female Acne Scoring Tool (AFAST) grading at 4-week intervals. The success rate, defined as the proportion of participants achieving a “clear/almost clear” AFAST grade by the end of week 12, was considered as the main outcome. Treatment-related adverse events (TRAE) were recorded. We enrolled 63 participants in the study. The total acne counts decreased significantly in all three groups (P < 0.05) as compared with baseline. Participants in the SPL50 group had a significantly higher success rate than those in the placebo group (P < 0.05). Serum potassium and creatinine levels showed no significant changes with treatment or between groups. A small number of participants in SPL25 and SPL50 reported mild and temporary TRAE, such as menstrual irregularities, breast tenderness and dizziness. The combination of SPL 50 mg/day and topical BP proved effective in improving moderate AFA in Thai women, with an acceptable side-effect profile. We propose this regimen as an option for treating moderate AFA.     

痤疮患者外周血IL-6、TNF-α表达水平及其与痤疮严重程度的相关性研究

 

目的: 检测痤疮患者外周血中IL-6、TNF-α表达水平,并分析两者与痤疮严重程度的相关性。方法：收集我院皮肤科门诊诊治的寻常痤疮患者114例,其中轻度35例、中度43例、重度36例,另选择同时期健康体检者30例作为对照组。使用化学发光法检测治疗前及治疗后4周血清中IL-6、TNF-α的水平,并对结果进行比较分析。结果：轻、中、重度痤疮患者外周血中IL-6水平差异有统计学意义（P<0.01）,而TNF-α水平无明显差异（P=0.243）。轻度、中度、重度患者IL-6水平均高于对照组（P值均<0.05）,而不同严重程度患者组间IL-6水平差异无统计学意义（P值均>0.05）。痤疮严重程度与IL-6、TNF-α水平均无明显相关性（P值均>0.05）。 结论：IL-6参与了痤疮的炎症反应,但不能用于评估痤疮病情的严重程度。TNF-α与痤疮之间的关系仍需进一步深入研究。

     

痤疮患者皮肤生理功能测定

目的 探讨痤疮患者面部皮肤生理功能的特点，以期指导痤疮患者的治疗。方法 选取受试对象120例，试验组为痤疮患者60例，其中男20例，女40例，平均年龄23.4岁；对照组为健康志愿者60例，其中男20例，女40例，平均年龄25.1岁。运用无创性皮肤生理功能测试仪，测量受试者的面颊及T区（油脂分泌旺盛区域）皮肤油脂、面颊皮肤弹性和水分。结果 试验组面部T区油脂量为（199.98 ± 58.21） μg/cm2，健康对照组为（117.55 ± 63.16） μg/cm2，两组差异有统计学意义（t = 7.34，P < 0.05）。试验组面颊油脂量为（154.45 ± 55.06） μg/cm2，健康对照组为（87.50 ± 47.36） μg/cm2，两组差异有统计学意义（t = 7.14，P < 0.05）。试验组皮肤弹性（0.7931 ± 0.0755R）与健康对照组（0.7882 ± 0.0498R）比较，差异无统计学意义（P > 0.05），试验组皮肤水分（30.75% ± 3.87%）与健康对照组（30.94% ± 2.91%）比较，差异也无统计学意义（P > 0.05）。结论 痤疮患者颜面皮肤油脂分泌过多。     

Effects and side-effects of spironolactone therapy in women with acne

BACKGROUND AND AIMS: Androgen hormones play an important role in the pathogenesis of acne. Despite the demonstrated effects, spironolactone, an androgen receptor blocker, is not commonly used to treat acne. We planned an open-labelled, prospective study to evaluate the effects and side-effects of spironolactone therapy in women with acne. MATERIALS AND METHODS: Thirty-five consecutive patients with acne were treated with spironolactone 100 mg/day, 16 days each month for 3 months. The patients were divided according to the clinical severity of the lesions as having mild, moderate and severe acne. Serum total testosterone and dehydroepiandrosterone sulfate (DHEAS) levels were measured before and after treatment. Lesion numbers and hormone levels before and after treatment were compared with one-sampled t-test. RESULTS: The mean age of the patients was 21.4 +/- 3.5 years. Two patients discontinued the study due to side-effects. Five patients were lost in the follow-up. Clinically significant improvement was noted in 24 patients (85.71%). No response was seen in four patients. All of the nonresponding patients had received previous unsuccessful therapies. Mean number of lesions and mean DHEAS levels of the 24 patients with clinical improvement decreased significantly after treatment (P < 0.01 and P < 0.05, respectively). There was no change in the mean total testosterone levels before and after treatment (P > 0.05). CONCLUSION: Spironolactone is a safe and effective medication for women with acne vulgaris. Although its side-effects seem to be high, they are in the majority of cases not a reason to stop treatment.     

Inflammatory skin is associated with changes in the skin microbiota composition on the back of severe acne patients

Acne is the most common inflammatory skin disease, affecting up to 85% of the 11‐30 years old world population. Skin microbiota appears as a key player involved in several skin dermatoses physiopathology. Here, we show that inflammatory skin is associated with changes in the skin microbiota composition on the back of severe acne patients but also on the face of patients where acne was scored as mild to moderate, comparing with healthy controls. Changes were observed particularly on skin commensals Propionibacteriaceae, Staphylococcaceae and Enterococcaceae families, suggesting the importance of the balance between skin commensals to maintain skin homeostasis and control skin inflammatory process.     

Efficacy of the combined use of a facial cleanser and moisturizers for the care of mild acne patients with sensitive skin

Acne is a common skin disease that involves the seborrheic area of the face and results from the obstruction of hair follicles followed by inflammation. Careful face washing helps to improve and prevent acne; however, intensive washing has a risk of inducing skin barrier impairment and dry skin, especially in sensitive skin. We hypothesized that skin care combining mild skin cleansing and intensive moisturizing (“combination skin care”) may be effective in the care of acne in subjects with dry skin and/or sensitive skin. We developed a combination skin care with a weakly acidic foaming facial skin cleanser based on a mild detergent, an aqueous lotion with eucalyptus extract and a moisturizing gel containing pseudo‐ceramide and eucalyptus extract. To optimize an ideal facial skin care system for mild acne on sensitive skin, we performed a 4‐week clinical trial with 29 post‐adolescent Japanese women with mild acne with dry and sensitive skin. The acne significantly decreased after this trial accompanied by the improvement of dry skin, a significantly increased endogenous ceramide level in the stratum corneum and an elongated alkyl chain length of the non‐hydroxy acyl sphingosine type ceramide. No adverse events due to the test samples were observed. Based on diagnosis by a dermatologist, 97% of the subjects found the combination skin care to be “useful” or “slightly useful”. Based on these findings, the combined use of a facial skin cleanser and moisturizers is safe and effective for the care of acne in post‐adolescent Japanese women with sensitive skin.     

痤疮患者血浆雄激素水平及白细胞雄激素受体的测定

为探讨痤疮患者外周血雄激素及白细胞雄激素受体（AR）含量对痤疮发生发展的影响，对35例痤疮患者和35名正常对照采用放射配体结合分析法测定白细胞雄激素受体含量，同时用放射免疫法检测血浆雄激素水平，结果：男性痤疮患者，血浆睾酮仅轻度升高，但其外周血白细胞AR的水平与对照组相比有明显升高（P＜0．05），女性痤疮患者，血浆睾酮水平及外周血白细胞AR水平与对照组相比均明显升高（P＜0．01），雄激素及其受体含量增高在女性痤疮的发病中可能起着重要的作用，痤疮的严重程度与睾酮水平及白细胞AR水平密切相关。